MEDICARE: DEANNA DREW SHEFFIELD RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PTH3146	AL

General Provider Information

NPI Number	:	1467671768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA DREW SHEFFIELD RPT

Provider Business Mailing Address
First Line	:	42229 BAYOU RD
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-7891
Country	:	US
Telephone Number	:	251-580-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N HOYLE AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4827
Country	:	US
Telephone Number	:	251-580-8236
Fax Number	:	251-580-8239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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